Cooperating defibrillators and external chest compression devices

ABSTRACT

Devices, methods, and software implementing those methods for providing communicating external chest compression (ECC) devices and defibrillation (DF) devices, where the ECC and DF devices can be physically separate from each other. Both ECC and DF devices are able to operate autonomously, yet able to communicate with and cooperate with another device when present. Some ECC and DF devices are adapted to be physically and/or electrically coupled to each other. One ECC device includes a backboard, a chest compression member, a communication module, controller, and at least one sensor, electrode lead or electrode. One DF device includes a defibrillator module, a controller, and a communication module that can communicate with the ECC communication module. The communicating ECC and DF devices may deliver ECC, pacing, defibrillation, ventilation, and cooling therapies, and may deliver instructions to human assistants, in a coordinated and cooperative fashion.

RELATED APPLICATIONS

The present application claims priority to U.S. Provisional PatentApplication No. 60/447,587, filed Feb. 14, 2003, titled COOPERATINGDEFIBRILLATORS AND CPR DEVICES, herein incorporated by reference in itsentirety. The present application is related to U.S. patent applicationSer. No. 10/652,392 titled INTEGRATED EXTERNAL CHEST COMPRESSION ANDDEFIBRILLATION DEVICES AND METHODS OF OPERATION, and to U.S. patentapplication Ser. No. 10/652,965 titled DEFIBRILLATORS LEARNING OF OTHERCONCURRENT THERAPY, now abandoned, both filed on date even herewith.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is related to the field of resuscitation devices.

2. Description of the Related Art

All over the world, people experience resuscitation events. For example,both in and out of the hospital, there is a significant incidence ofcardiac and/or respiratory arrest among at-risk patients. When an acuteevent occurs, a variety of therapies may need to be administered torestore the patient's normal function. The patient may requireartificial respiration to stimulate breathing, chest compressions torestore perfusion, defibrillation to activate the heart, and/or pacingto promote cardiac output.

Many devices exist which can separately administer these therapies inthese events and situations. For example, an automated chest compressiondevice is taught in patent U.S. Pat. No. 6,234,984 B1. Some of thesedevices even aggregate various features, such as are described in U.S.Pat. No. 4,349,015, and U.S. Pat. No. 4,424,806.

Many of the prior art devices, however, merely collect such featuresinto a single package, without synchronizing their functions and makingthem work together. Therefore there exists a need for devices that cancombine, coordinate and integrate various aspects of these diagnosticsand therapies to better assess and treat the patient. That is becausemany of these conditions occur in combination, requiring that therapiesblend constructively with one another to be optimally effective.

SUMMARY OF THE INVENTION

Generally, the present invention provides devices, software, and methodsas described below. The invention offers devices that can operateindependently, or in a combined fashion, to monitor a patient andadminister diverse therapies, as they arise. Systems provided by thepresent invention preferably include a device for providing externalchest compression and a defibrillator, where the chest compressiondevice and defibrillator can each operate autonomously when necessary,yet can also each communicate with and cooperate with each other whenadvantageous.

One system provided by the present invention includes an external chestcompression (ECC) device having a first communication module, and adefibrillator having a second communication module, in which the ECCdevice and the defibrillator are capable of communicating via the firstcommunication module and the second communication module. The datacommunication modules can utilize a communications medium selected fromthe group consisting of wireless, radio frequency, infra-red light,light, hard-wired electrical, and coupled optical fibers.

Some ECC devices include a backboard, and can also include wheels and ahandle. A chest compression member can be coupled to the backboard,where the chest compression member can include a rigid chest compressionmember and/or a retractable or contractible belt or vest. Some chestcompression members are driven by powered actuators while others aremanually operable. ECC devices can also include cooling modules forcooling a person and ventilators for ventilating.

ECC devices, on the backboard, on the chest compression members, and/oron the defibrillation device, can include various sensors, electrodes,and leads, which can include sensors for measuring physiologicalattributes, one or more defibrillation electrodes, and one or more EGGleads. Electrodes may include a releasable electrolyte. Sensors canmeasure applied chest pressure, temperature, respiration, pulse, ECGsignals, EEG activity, thoracic impedance, and other parameters. Thesensors, electrodes, and leads are preferably coupled to thecommunication module of the respective ECC or defibrillation device.Some systems include a communication module on either or both of the ECCdevice and defibrillator that can communicate with a remote assistancecenter. A camera can be coupled to the communication module.

Some ECC devices and defibrillators are adapted to be physically and/orelectrically coupled to each other. Some defibrillators can beelectrically coupled to defibrillation electrodes on the ECC device.

The ECC device and/or the defibrillator preferably includes a controlleror processor that is coupled to the respective bidirectionalcommunication module. In systems having at least two controllers, eachcontroller may execute logic to designate a master controller, and alsoslave controllers, as between the two or more controllers. Variousmethods may be executed in the controllers, including the master and/orslave controllers, depending on the embodiment.

One method according to the present invention includes placing a personon a first device, establishing data communication between the firstdevice and a second device that can be physically apart from the firstdevice, causing a chest compression member of the first device tocompress the chest of the person against the backboard, and causing adefibrillator of the second device to defibrillate the person responsiveto the communication. Placing the person on the first device can referto placing the person on a portion of the first device, for example on abackboard, or on a vest or belt which encircles the person. Someembodiments utilize a constrictive vest or belt and do not include abackboard or backframe. The communication may be used either tosynchronize the delivery of the defibrillator shock with an optimal timein the compression cycle, or to avoid applying the defibrillator shockat a vulnerable period in the compression cycle. The communication aboutdefibrillator activity may, in turn, be used to initiate, pause, orterminate chest compressions, or to change operating parameters of theECC device, such as rate and/or depth of chest compression. In somemethods, placing the person on a backboard of the first device resultsin the person contacting a defibrillator electrode of the first device.

Some methods include therapies, including pacing, ventilating, cooling,and other modalities, and providing ECC responsive to data communicatedbetween or among the separate devices. The therapies performed on theperson can be automatic, manual, or prompted manual mode, in response tovoice instructions from any of the devices.

Some systems include a controller executing logic for generating anoutput to control a chest compression actuator in combination with adefibrillator, responsive to sensor data indicative of the presence ofcardiac arrest and that indicate the response of the patient to therapy.In one example, a sensor may detect that a patient is in cardiac arrest(for example, some combination of asystole or VF on the ECG, lack of apulse, and no respiratory and/or EEG signal) or pulseless electricalactivity (PEA) (for example, some combination of R-wave activity on theECG and lack of a pulse). Alternatively, the sensor may detect that thepatient has a perfusing rhythm, such as sinus activity (for example,R-wave activity, a regular pulse, and adequate respiration.)

Perfusion may be stimulated when controllers execute logic in responseto sensor inputs to implement methods to administer automatic chestcompressions, as in cardiac arrest or PEA. Further sensor readings canestablish whether adequate perfusion has been stimulated, for example,by the return of pulse or EEG signals, and the device may recommend orself-adjust based on sensor readings to set an optimal rate and/or depthof chest compression. Some indication of the adequacy of perfusion andthe course of ECC therapy can be indicated to the operator and stored toa documentation log.

Similarly, it may be determined that defibrillation is required in orderto restore spontaneous cardiac contractions and to restore cardiacoutput. Sensors may initiate defibrillation responsive to physiologicalsignals indicative of ventricular fibrillation or ventriculartachycardia. A defibrillation shock can be administered under manual orautomatic control, synchronized to the activity of the ECC device, andthe response of the patient can be determined by further reference tothe sensors (e.g. pulse or ECG).

Again, sensors may indicate that a patient is failing to ventilateproperly, or only with difficulty. Manual or automatic ventilation maybe initiated in conjunction with, and the effectiveness determined byreference to sensors (e.g. CO₂ or oximetry). Optimal rate and depth, orpossibly gas mixture, may be determined and recommendations made to theoperator. The interaction between sensors and therapies may again beused to establish a care record in a documentation log. Similarly, otheradjunct therapies (hypothermia and others) may be applied when thesensors indicate that their effect is beneficial and safe for thepatient. ECC may be started, paused, or stopped in relation to theseadjunct therapies.

Each independent therapies may be applied alone or in combination. But apatient in cardiac arrest may benefit most from a synchronizedcombination of therapies, based on sensor readings. This could occurwhen a patient has been placed on an ECC device and instructionsgenerated to establish communication between a first data communicationmodule operably coupled to the ECC device and a second datacommunication module coupled to a defibrillator. Sensors may determinethat a patient is in cardiac arrest, and, for example, may furtherindicate that the patient has been in a non-perfusing state for a periodlonger than 5 minutes. The device would recognize that a period of chestcompressions should be initiated, sufficient to perfuse the patient, fortwo minutes before applying a defibrillation shock. The effectiveness ofchest compression could be monitored, and the duration of stimulatedperfusion measured. After two minutes, a defibrillation shock could beautomatically applied. It may be desirable to initiate the shock duringa chest compression, or between them, with such synchronization beingperformed to enhance shock effectiveness. Sensors detecting there-appearance of a perfusing ECG rhythm may initiate a 30-second periodof pacing to further stimulate cardiac function. Alternatively, failureto restore a perfusing rhythm may cause a further period of CPR,followed by another defibrillation shock, to be administered. In allcases, available therapies can be synchronized and combined in waysresponsive to the patient's condition, and in ways that complement eachother's effectiveness.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a system including a cooperating,communicating, and physically separate external chest compression (ECC)device and defibrillation device;

FIG. 2 is a perspective view of the system of FIG. 1, having a persondisposed on the ECC device, and the ECC and defibrillation devicesdirectly coupled to each other;

FIG. 3 is a perspective view of a person disposed on another system ECCdevice having a shorter backboard relative to the ECC device of FIG. 1,and having the defibrillation electrodes on the person; and

FIG. 4 is a transverse, cross-sectional view of an ECC device in whichthe chest compression member includes a belt and a piston;

FIG. 5 is a transverse, cross-sectional view of an ECC device in whichthe chest compression member includes a retractable belt;

FIG. 6 is a transverse, cross-sectional view of an ECC device in whichthe chest compression member includes rigid members pivotally coupled tothe backboard;

FIG. 7 is a transverse, cross-sectional view of an ECC device having apowered actuator coupled to a force multiplier for delivering chestcompression;

FIG. 8 is a perspective view of a system including a cooperatingexternal chest compression (ECC) device and a separate defibrillationdevice, in which the ECC device includes a posterior electrode in thebackboard and an electrical connection coupled to the defibrillationdevice;

FIG. 9 is a fragmentary, perspective view of a system including acooperating external chest compression (ECC) device and a separatedefibrillation device, in which the ECC device includes electrodes forreceiving defibrillator paddle electrodes for electrically coupling tothe defibrillation device;

FIG. 10 is a fragmentary, bottom view of a belt bearing a defibrillatorelectrode;

FIG. 11 is a fragmentary, bottom view of a belt bearing twodefibrillator electrodes;

FIG. 12 is a fragmentary, bottom view of a belt bearing multiple ECGleads;

FIG. 13 is a fragmentary, bottom view of a belt bearing multiple sensorsand associated leads;

FIG. 14 is a fragmentary, transverse cross-sectional view of a belt orvest bearing a spring biased defibrillator electrode, ECG lead, orsensor;

FIG. 15 is a fragmentary, transverse cross-sectional view of a belt orvest bearing an electrode, lead, or sensor having an electrolyte gel;

FIG. 16 is a schematic view of an ECC device and defibrillator similarto those FIG. 1, further including communication modules incommunication with a camera and transmitter communicating with a remoteassistance center;

FIG. 17 is a schematic view of the ECC device of FIG. 1, furtherincluding a cooling module in the form of a cooling garment disposed onthe person;

FIG. 18 is a highly diagrammatic, cross-sectional view of the person andcooling garment of FIG. 17;

FIG. 19 is a view of a sample screen of a defibrillator according to theinvention, when it requests cooperation with an ECC device according tothe invention;

FIG. 20 is a view of a sample screen of the ECC device of FIG. 19, whenthe request is received;

FIG. 21 is a view of a sample screen of the defibrillator of FIG. 19, asthe handshake is being established;

FIG. 22 is a block diagram of the controller or computer containingexecutable logic or software contained within an ECC and/ordefibrillation device;

FIG. 23 is a flow chart illustrating a method for performing coordinatedexternal chest compression and defibrillation therapies;

FIG. 24 is a time diagram showing coordinated periodic chestcompressions and defibrillation and/or pacing pulses;

FIG. 25 is a flow chart segment illustrating an optional pacing portionof the flow chart of FIG. 18; and

FIG. 26 is a view of a display screen from an operation of theinvention.

DETAILED DESCRIPTION

According to the invention, an external chest compression (ECC) deviceis provided, and also an external defibrillator. In addition, each hasan interface for communicating with the other, and optionally also forcooperating for maximum effect. The interfaces are made compatible witheach other, as further described below.

An important aspect of the invention is that the external defibrillatoris capable of functioning autonomously, independently of the externalchest compression device when they are not communicating or cooperating.It is also highly preferable that the external chest compression devicebe capable of functioning autonomously, independently of the externaldefibrillator when they are not communicating or cooperating.

FIG. 1 illustrates a system 60 for performing coordinated ECC anddefibrillation including an external chest compression (ECC) device 30and an external defibrillation device 68. ECC device 30 includes abackboard or back frame 32, chest compression members 40, a ventilator42, an ECC human interface module or I/O module 54, and a communicationmodule 62 for communicating with external defibrillation device 68.

Backboard 32 is shown as solid and having an upper surface 34. Backboard32 need not be solid. Backboard 32 is preferably made as lightweight aspossible, allowing the integrated modules to be included without addingunneeded weight. In some embodiments, wheels 36 and a handle 38 arecoupled to backboard 32. This permits the device to be used as a gurney,making it easier to transport the patient.

The chest compression portion may be implemented in a number of ways, asdescribed below. Two chest compression members 40 are shown, in the formof two arms. Chest compression members 40 are coupled to backboard 32.Even though only two arms are shown, the chest compression members maybe implemented as a belt, and/or as a vest, either a full or partialvest. The belt or vest is intended to generally wrap around the chest ofthe patient, for squeezing it, or squeezing it against backboard 32. Inthis way, ECC or CPR can be administered to the patient. The belt orvest may incorporate other functionalities, as further described below.In addition, it may be removable and/or reusable.

ECC device 30 can further include ventilator or ventilating module 42.Ventilator 42 can include ventilator tubing 44. Ventilator 42 can alsobe coupled to backboard 32 and can be used for ventilating the patient.Ventilator 42 is shown schematically, as ventilators are well known tothose skilled in the art.

Human interface module 54 can be implemented in a number of ways. Humaninterface module 54 can include an input portion and an output portion.The input portion can include a keyboard and the output portion caninclude a visual display or computer screen and/or a voice output modulefor interacting with a human assistant. Human interface module 54 canhave input devices such as keys, switches, knobs, levers, and amicrophone for recording and preferably also voice recognition. Thehuman interface device can also have output devices such as one or moredisplay screens, a speaker, a printer, and other output devices. All ofthese functions may be aggregated at the human interface module, forexample, using a keypad.

In addition, the ECC device may include advanced features for availingto a defibrillator, when one is coupled with it. This may be useful whenthe defibrillator is a unit that lacks many capabilities on its own.Having these features permits using a defibrillator that itself lacksthese features.

A battery 52 can be carried within backboard 32 for supplying power foroperating human interface device 54, ventilator 42, and chestcompression members 40, in the various embodiments of the invention. lnsome systems, battery 52 can also be used to power the externaldefibrillator, where the defibrillator can be electrically coupled tothe ECC device. A controller or computer can also be included withinhuman interface device 54 or elsewhere within ECC device 30 forcoordinating the operation of external chest compression,defibrillating, pacing, and ventilating, depending on the embodiment ofthe invention present.

External defibrillation device 68 includes a defibrillation humaninterface 70 including an input portion 72 and an output portion 73. Theinput portion can include a keyboard and the output portion can includea visual display or computer screen and/or a voice output module forinteracting with a human assistant. Defibrillation device 68 alsoincludes defibrillation electrodes 76 and a defibrillation communicationmodule 64. Defibrillation communication module 64 may be seencommunicating with ECC device communication module 62 throughcommunication channel 66.

FIG. 2 illustrates system ECC device 30 having a person or patient 100disposed on backboard 32. Patient 100 has a chest disposed under chestcompression members 40 and a mouth for receiving ventilator tubing 44.Defibrillator device 68 has been moved toward ECC device 30. In someembodiments, ECC device and defibrillator device 68 can be electricallyand/or mechanically coupled to each other through electrical connectorsand/or cables, allowing defibrillation pulses from the defibrillator tobe delivered through defibrillation electrodes of the ECC device.

FIG. 3 illustrates another system including an ECC device 120, forproviding cooperating external chest compression and defibrillationand/or pacing. ECC device 120 may be seen to include chest compressionmembers 40, human interface device 54 and battery 52, as previouslydescribed with respect to FIG. 1. ECC device 120 includes a shortbackboard or back frame 126. Shorter backboard 126 can decrease theweight and increase the portability of the ECC device.

Compressing and releasing may be performed according to any type of timeprofile. One such profile is seen in FIG. 24. Other profiles may be sinewave, triangular shaped, or other shapes. In an advantageous embodimentof the invention, a sine wave may be used with a frequency outside theECG range. The chest compression profile shape and frequency may permitanalyzing the ECG while simultaneously performing chest compressions.This may also permit the device to detect more quickly a rhythm thatrequires a defibrillation shock, and to reduce the delay of its deliveryfrom the end of the chest compressions.

Other embodiments of the chest compression portion includes devicesperforming active compression decompression, devices that combine chestcompressions with abdominal compressions, devices where the belt isoperated electronically (w/o gears), and devices that use electricity todo chest compressions by electrically inducing chest muscles tocontract.

Referring again to FIGS. 1, 2, and 3, the invention externaldefibrillation device is capable of performing defibrillation, andoptionally, also pacing. Pacing may be implemented by a separate modulethan defibrillating, but it is highly advantageous to have the samemodule perform both functions. The defibrillator may be of any chosenautomation level. That includes operation that is fully automated tofully manual, and every option in between.

Moreover, the defibrillator may also advantageously provide devices ormodules that perform monitoring, and further provide interpretation ofthe monitored signals. The monitoring results may advantageously bedisplayed on the human interface device previously described or on anI/O module as described below. In other embodiments, there is a separatemonitoring module. Monitoring may be of any of the monitoring parametersor physiological attributes common on defibrillator/monitors or bedsidemonitors today, for example, NIBP, SpO₂, CO₂, 12 lead ECG, etc. In otherembodiments, monitoring is performed by the ECC device, and may betransmitted to the defibrillator.

The defibrillator also can include an input/output (I/O) or humaninterface module as previously described. In the embodiment of FIG. 1,defibrillator human interface device 70 includes a display screen andkeyboard, as previously discussed, but that is not limiting. Theinvention can also have input devices such as keys, switches, knobs,levers, a microphone for voice recording, and preferably also voicerecognition, and output devices such as one or more screens, a speaker,printer, or other output device. All of these are preferably aggregatedat the I/O module, but that is not necessary for practicing theinvention. They may be located elsewhere in the devices, or receivedremotely, for example, wirelessly.

The ECC device also optionally includes a ventilation portion. Aventilation portion or ventilating module 42 was previously describedwith respect to FIG. 1. The ventilation portion may be implementedeither automatically, or be intended for use by a human operator. If bya human, the device may be made giving prompts for instructing therescuer. The prompts may be timed. The rescuer may be either performingmouth-to-mouth resuscitation or opening a bag valve mask device wherethe user manually squeezes the bag. If the ventilator is to beautomatic, a tube can be inserted into the patient's mouth, and a pumpcan be used. A mask may be placed on the face of the patient. The oxygencan be delivered this way to the patient. Other devices, such as valvesthat block the airway during chest decompression, for example, a CPR-xvalve, can be included in the ventilation portion of the device of theinvention.

The ECC device preferably also includes an electrical power source forpowering the various ECC portions. The power source may be a battery,such as battery 52 discussed with respect to FIG. 1. The battery may beeither a rechargeable battery for maximum portability, or a replaceablebattery. The battery is preferably integrated with the back frame,either permanently, or in such a way that it can be removed andreplaced. Some devices of the invention have the benefits of being ableto share a common power source, CPU or controller, and I/O module forthe interface with the rescuer. FIG. 4 illustrates an ECC device 150, inwhich the chest compression is effected by a compressor or expandablemember held in place by a belt or vest 153, depending on what isprovided in the particular embodiment. The chest compressor includes amechanism for pushing downwards on the chest. In the ECC deviceillustrated, the compressor is implemented as a base 151 and a piston152. Piston 152 is illustrated in a first, retracted position 154 and asecond, extended position 156. Belt or vest 153 can be coupled to a backframe 158, as previously discussed. A posterior electrode 48 is embeddedin the back frame 158.

FIG. 5 illustrates an ECC device 170 with a belt or vest 172, having abuckle or zipper 174 for fastening around the chest of the patient. Beltor vest 172 can itself be contracted to effect chest compression. Thecontraction can take place in many ways. In one way, the belt or vestcan be retracted into a back frame 176. In another way, belt or vest 172can be constricted about the patient. Belt or vest 172 may be seenhaving a first, expanded position 173 and a second, constricted position178. In yet another way, chest compression is effected by electricallystimulating the chest muscles. A posterior electrode 48 is embedded inthe back frame 158.

FIG. 6 illustrates still another ECC device 200 having a patient 206disposed on a backboard 210. In device 200, chest compression isprovided by rigid chest compression members or arms 202 having supportprongs 208 that push down on the chest of patient 206. Arms 202 can bepivotally coupled to backboard 210. In the embodiment illustrated, arms202 are operated by gears 204 that are integrated with backboard 210. Insome embodiments, arms 202 are driven by a powered chest compressionactuator.

FIG. 7 illustrates another ECC device 220 including backboard 210carrying patient 206, as previously described. ECC device 220 includes aforce multiplier 224 using a lever arrangement, so that a pressingmember can exert a downward pressure on the patient chest. ECC device220 includes a gearbox or a powered actuator 230 coupled through a shaftor rod 228 that may be hollow in some embodiments. Shaft 228 can havefirst force transmission member 236 slidably received within shaft 228and pivotally coupled to a second force transmission member 232 and athird force transmission member 234. Force transmission members 232 and234 can be further coupled to a chest compression pad 235 for pressingagainst the chest of patient 206. Force multiplier device 224 can beheld in place by a belt or vest 222. In some embodiments, the leverarrangement may operate by having a rod conduct a long rotation, such asin a corkscrew arrangement.

Other embodiments of the chest compression portion include beltscrossing the chest from over the shoulder down to the chest, forming an“X” across the patient's chest. This is better than the conventional wayof having belts horizontally across the patient's chest, in that itpermits placement of sensors such as leads in different places.Alternately, an “X”-belt configuration may be combined with theconventional configuration. In yet other embodiments, the chestcompression portion includes devices performing activecompression-decompression, devices that combine chest compressions withabdominal compressions, devices where the belt is operatedelectronically without gears, and devices that use electricity to dochest compressions by electrically inducing chest muscles to contract.Various embodiments may use combinations of these chest compressiontechniques.

FIG. 8 illustrates a system 250 including an external chest compression(ECC) device 252 and an external defibrillation device 254. ECC device252 can have backboard 32, human interface device 54, and ECC datacommunication module 62, as previously described. ECC device 252 furtherincludes chest compression members 256 having a built in electrode 264on the underside, and a posterior electrode 262 built into thebackboard, for availing to a defibrillator, when one is coupled with it.Electrodes 264 and 262 are placed on the patient by virtue of applyingthe ECC device. In the example illustrated, one electrode can beintegrated with the chest compression portion, and the other on the backframe. In another example, both electrodes may be integrated with thechest compression portion. Instead of applying the externaldefibrillator electrodes to the patient, special wires can be appliedfrom the external defibrillator to a defibrillator electrode interfaceor connector 260 on the back frame. Those in turn can power the ECCdevice built in electrodes. In the embodiment illustrated, an electricalcable 266 may be seen extending from defibrillator 254 to ECC device252.

Referring to FIG. 9, an optional embodiment is shown. In the system 270,an ECC device 222 includes two electrodes 274 on the back frame forplacing thereon directly the defibrillator electrodes 258. This way, nospecial wires are needed.

FIGS. 10 and 11 illustrate how defibrillator electrodes or otherelectrodes might be attached to an underside of the vest or belt of thechest compression portion of the devices of FIG. 1, 2, or 3. Forexample, the electrodes can be part of a belt or vest of FIG. 4 or 5.The electrodes can also be integrated with an arm or a prong of a chestcompression member, for example, prong 208 of FIG. 6 or chest contactpad 235 or FIG. 7.

FIG. 10 illustrates a belt or vest having a first portion 300 coupledthrough a buckle or zipper 304 to a second portion 302. A firstelectrode 306 may be affixed to the underside of the belt or vest andcoupled to a wire or lead 308. In FIG. 10, one of the electrodes issituated on the underside of the belt or vest, while the other electrodemay be expected to be in the backboard. At least one wire can connectthe electrode to the remainder of the defibrillation/pacing portion.This is a preferred embodiment, since it would minimize CPR artifact inthe ECG signal. The electrode preferably avoids the center of the chest.That is where the buckle or zipper is shown (as wider than the openportion that supports the electrode).

FIG. 11 illustrates the belt or vest of FIG. 10, having belt or vestfirst portion 300, buckle or zipper 304, and second portion 302. Firstelectrode 306 and wire 308 are as previously described with respect toFIG. 10. In FIG. 11, a second electrode 310 is coupled to a second wireor lead 312. In the embodiment illustrated in FIG. 11, no electrode isneeded in the backboard or back frame for traditional defibrillation. Atleast one wire can connect each electrode to the defibrillation/pacingportion.

FIG. 12 illustrates the underside of another belt or vest having a firstportion 320 coupled through a buckle or zipper 324 to a second portion322. Belt or vest first portion 320 may be seen carrying a firstelectrode 326 and a second electrode 327, coupled to wires 332. Belt orvest second portion 322 may be seen carrying third electrode 328, fourthelectrode 329, and fifth electrode 330, all coupled to wires 332. Wires332, while having similar reference numbers, are, of course, preferablyelectrically distinct. The ECG leads of FIG. 12 are also preferablyintegrated with the underside of the vest or belt of the chestcompression portion of the devices of FIG. 1, 2, or 3. The ECG leads maybe placed so as to not interfere with any defibrillation electrodes, forexample, those of FIGS. 10 and 11.

FIG. 13 illustrates yet another belt or vest having a first portion 340coupled through a buckle or zipper 344 to a second portion 342. Theunderside of belt or vest first portion 340 may be seen carrying a firstsensor 346 coupled to a wire or other signal transmission medium 349.The underside of belt or vest second portion 342 may be seen carrying asecond sensor 347, and a third sensor 348, coupled to wires 349. Thesensors are preferably also integrated with the underside of the vest orbelt of the chest compression portion of the devices of FIGS. 1, 2 and3. These sensors can include pulse detection sensors, such as those madefrom piezoelectric materials, temperature sensors, CO₂ sensors, andother sensors for measuring physiological attributes or signals, wellknown to those skilled in the art.

The features integrated with the belt or vest are preferably arranged sothat they do not interfere with each other. The electrode may be fullyintegrated, or detachable for servicing. Alternately and equivalently,some electrodes, ECG leads, or sensors may be hosted in the backboard.

FIGS. 14 and 15 illustrate how defibrillator electrodes, ECG leads, orsensors may be integrated with an underside of the vest, belt, or otherchest compression members, for example those in FIG. 1, 2 or 3.

FIG. 14 illustrates a belt or vest 350 carrying an electrode, lead, orsensor 352. Electrode, lead, or sensor 352 can be coupled to a wire 356and biased downward from the belt or vest with a spring 354, so as to bepressed against the chest of the patient. For use with a pulse sensor,some quieting time for the spring is preferably allowed, so as to notprovide interference with the signal.

FIG. 15 illustrates a belt or vest 360 carrying an electrode, lead, orsensor 362 on the underside of the vest or belt. A gel or electrolyte364 may be seen on the underside of the electrode, lead, or sensor 362.For implementing an electrode, a gel may be administered, or anelectrolyte may be diffused. The gel or electrolyte may be provided in acapsule that bursts at an appropriate time to release it. The time maybe prior to defibrillation electrotherapy. Bursting may be caused by themere pressure against the chest, or by an appropriate electrical signal.One advantage that can be provided by some embodiments is that there isno need to disrobe the patient —the fluid may seep through the clothesto establish electrical conduction.

FIG. 16 illustrates some other optional features of the invention. ECCdevice 30, patient 100, and backboard 32 are shown, as previouslydescribed. A camera 382 may be seen disposed on a post secured tobackboard 32. Camera 382 can be coupled to a communication module 380that can act as a transmitter or transceiver. Communication module 380can communicate with a remote assistance center 396 coupled through anetwork 394 and a remote antenna 392. A data/voice/video communicationslink 386 is shown as existing between communication module 380 andremote assistance center antenna 392. Communication link 386 can bebi-directional in some embodiments.

A data/voice/video communications link 390 is shown as existing betweencommunication module 380 and defibrillation device communication module384. Yet another communication link 388 may be seen betweendefibrillation device communication module 384 and remote assistancecenter antenna 392. Communication links 390 and 388 are also preferablybi-directional. In a preferred embodiment, communications modules 380and/or 384 include the functionality of a portable telephone and canestablish wireless communication with remote antenna 392, and network394 is a network that can support voice and/or data communications.

Camera 382 is preferably a digital camera, and may be either a videocamera or a still camera. A camera may be advantageously attached to apost in the backboard and/or to the defibrillation device. The camera ispreferably attached to the ECC device. The camera permits recording ofthe scene and the patient. The recording may be used for record keeping,event analysis, and other purposes. Alternately, the recording may beused for live transmission to the remote assistance center 396, wheremore trained medical personnel can in turn provide feedback.

The user may use the defibrillator of the invention and/or the chestcompression device of the invention to assist a victim. In addition, theuser can establish a communication link 386 and/or 388 with remoteassistance center 396. Then the information can be transmitted and caninclude images, if a camera is provided. The patient's vital signs,encoded by the invention for communication, along with the rescuer'scomments, observations, and even questions may be also transmitted tothe remote assistance center.

If the defibrillator of the invention and the chest compression deviceof the invention are interfaced, then only one communication link needbe established with the Remote Assistance Center. The inputs from theother device can be passed via the interface.

In some embodiments, the invention is operable from remote assistancecenter 396. An operator at the remove assistance center can transmit acommand code through communication link 392 to ECC device 30 and to thedefibrillation device, and the devices operated accordingly. Suchoperation may actually include defibrillation and/or ECC.

Moreover, the monitored data, included also recorded data such asevents, wave forms, physiological signals or attributes, and dataindicative of the device operation itself, may be also transmitted to asystem for collecting or storing patient information, and to acomputer-aided dispatch system for assistance. Furthermore, it may alsobe sent to a billing system for determining patient billing.

FIGS. 17 and 18 illustrate additional optional cooling figures of theinvention. Cooling can be provided for performing IMHT (Induction ofMild Hypo Thermia), which may slow down adverse effects of the eventsbeing experienced by the patient.

ECC device 30 and patient 100 are as previously described. FIG. 17illustrates generally a cooling module aspect of the present invention.In the example illustrated, the cooling module includes a liquid gasstorage container or tank 402 coupled to a valve 404 coupled in turn toa tube 406 coupled to a cooling garment 408. Liquid gas storagecontainer 402 can be included within the cooling module and ispreferably carried under the backboard. This is most advantageous in theevent the backboard is implemented with wheels.

The liquid in container 402 can be one that preferably turns into gasupon being released into the atmosphere. A cooling garment, similar tocooling garment 408, can be provided for each part of the body that isof interest to cool. As used herein, “cooling garments” include veryloose, tent-type cooling garments that allow cool air to be blown overthe patient. As used herein, “cooling garments” also include tightlyadhering garments that may contact the patient's skin or clothing andconduct heat away through conductive cooling. Some tightly adheringcooling garments are adhesively adhered to the patient's skin andconduct heat away through a thermally conductive coupling agent. Thecooling garment can be shaped to be suitable for placing over the bodilypart that is to be cooled. Cooling garment 408 illustrated in FIG. 17 isdesigned for placement on the patient's head. Cooling may also beaccomplished by evaporative cooling, for example, using a suitable fluiddelivery system and an absorber for alcohol, such as cotton.

FIG. 18 illustrates a section of cooling garment 408. Garment 408 has aninner shell 409 for contacting patient 100. Garment 408 also has anouter garment or shell 411 that defines an inner space 405 between outershell 411 and inner shell 409. Spacers may be used to maintain innerspace 405 in an open configuration. Alternately, small tubes may beused. Garment 408 can receive liquid gas from storage container 402 viatube 406 in communication with inner space 405. The cooling gas orliquid can also be received into the series of small tubes, previouslydescribed. The gas can then be released into the atmosphere from variousplaces in the garment. As it is being released, the gas can expand,cool, and thus draw heat away from the patient. Sensors, for example fortemperature, may also be included.

Referring again to FIG. 17, the gas can be directed from storagecontainer 402 to liquid controller or valve 404, and from there togarment 408 via tube 406. Liquid controller 404 can in turn becontrolled by an IMHT controller, for controlling the rate of cooling ofthe patient. The expanded cooled gas may be mixed with air to controlthe final cooling gas/air temperature. The IMHT controller may beimplemented in combination with the liquid controller, and optionallyfurther communicates with the processor or controller of the device ofthe invention.

In some embodiments (e.g. FIG. 2) the interface is physical, and thedevices are physically coupled to each other. In direct couplingembodiments, the external defibrillator may slide into a sheath of theback frame, and snap in place, making the required contacts. In otherembodiments, the external defibrillator is coupled with the back framevia one or more wires. A physical interface is necessary if adefibrillation shock is to be transmitted, as in FIG. 8.

In other embodiments (e.g. FIG. 3) the interface is wireless, and thedevices communicate without contacting each other. In that case, thedefibrillator electrodes are applied directly to the patient. Allowancemust be made for not interfering with the ECC device.

If the interface is wireless, it may use any one of many knowntechnologies and protocols for wireless communication. Favoredtechnologies are those that permit communication between devices thatare within 10 m (30 feet) from each other, such as 802.11 compatibledevices, Bluetooth devices, etc.

The interface can be established in many different ways. In the mostadvanced embodiments, both devices may exchange data with each other,and either may exercise control of the other. In other embodiments,either one of the devices of the invention may communicate to the other,but be able to receive no commands. Or they may be able to receivecommands, but not communicate to the other.

The exchanged data includes device data such as identification,settings, status, time stamps, etc. The exchanged data may also includeuser inputs, patient physiologic parameters, electrotherapy, etc. Thecontrol data may include the ability of one device to control the stateof the other; to recognize and interpret the inputs of the other formaking decisions. In addition, there can be “analog” connection totherapy electrodes, ECG electrodes, or other sensors.

The handshake may be established with the one device as “master” and theother as “slave”, or both as peers. A peer connection is not favored,since that might require a user to be operating two I/O modules. Inaddition, prompts in at least one of the devices might assist the userin connecting the device to the other.

The determination of which one should be master is preferably made bycomparing their relative capability to coordinate the devices. Such maystart even wirelessly, as they are brought close to each other. Anexample is described below.

FIG. 19 is a view of a sample screen 500 of a defibrillator according tothe invention, when it requests connection with an ECC device accordingto the invention. The device ID may be seen at 502. Remarks can bedisplayed at 504. The detection of a cooperating device is noted at 506.The coordination capability of the coordinating device is displayed at508. A master-slave relationship is initiated at 510.

FIG. 20 is a view of a sample screen 520 of the ECC, when the request isreceived. The device ID may be seen at 522. Remarks are displayed at524. The detection of a cooperating device is noted at 526. Receipt ofrequest for a master-slave relationship is displayed at 528. The use isprompted for acceptance of the master-slave relationship at 530.

The device that is in control preferably takes over all input/outputfunctionality. In addition, it takes control of operations of bothdevices under a single operation.

As the connection is established, compatibility is determined of thevarious functions, inputs, etc. An example is seen below.

Referring to FIG. 21, a screen 550 is shown of when compatibility isestablished at 558. The clocks are synchronized at 556. This may takeplace by coordinating the time stamps of the two devices, either byusing a common clock, or by communication of events, or by denoting adifference between the times shown by the clocks of the devices. Variousinputs are checked at 558, to see if they will be understood ifreceived.

The present invention may be implemented by one or more devices thatinclude logic circuitry. The device performs functions and/or methods asare described in this document. The logic circuitry may include aprocessor that may be programmable for a general purpose, or dedicated,such as microcontroller, a microprocessor, a Digital Signal Processor(DSP), etc. For example, the device may be a digital computer likedevice, such as a general-purpose computer selectively activated orreconfigured by a computer program stored in the computer. Alternately,the device may be implemented as an Application Specific IntegratedCircuit (ASIC), etc. These features can be integrated with theinvention, or coupled with it.

Moreover, the invention additionally provides methods, which aredescribed below. The methods and algorithms presented herein are notnecessarily inherently associated with any particular computer or otherapparatus. Rather, various general-purpose machines may be used withprograms in accordance with the teachings herein, or it may prove moreconvenient to construct more specialized apparatus to perform therequired method steps. The required structure for a variety of thesemachines will become apparent from this description.

In all cases there should be borne in mind the distinction between themethod of the invention itself and the method of operating a computingmachine. The present invention relates both to methods in general, andalso to steps for operating a computer and for processing electrical orother physical signals to generate other desired physical signals.

The invention additionally provides programs, and methods of operationof the programs. A program is generally defined as a group of stepsleading to a desired result, due to their nature and their sequence. Aprogram made according to an embodiment of the invention is mostadvantageously implemented as a program for a computing machine, such asa general-purpose computer, a special purpose computer, amicroprocessor, etc.

The invention also provides storage media that, individually or incombination with others, have stored thereon instructions of a programmade according to the invention. A storage medium according to theinvention is a computer-readable medium, such as a memory, and is readby the computing machine mentioned above.

The steps or instructions of a program made according to an embodimentof the invention requires physical manipulations of physical quantities.Usually, though not necessarily, these quantities may be transferred,combined, compared, and otherwise manipulated or processed according tothe instructions, and they may also be stored in a computer-readablemedium. These quantities include, for example electrical, magnetic, andelectromagnetic signals, and also states of matter that can be queriedby such signals. It is convenient at times, principally for reasons ofcommon usage, to refer to these quantities as bits, data bits, samples,values, symbols, characters, images, terms, numbers, or the like. Itshould be borne in mind, however, that all of these and similar termsare associated with the appropriate physical quantities, and that theseterms are merely convenient labels applied to these physical quantities,individually or in groups.

FIG. 22 illustrates a general computer, processor, or controller 440having a data storage device or computer readable medium 446 interfacedwith computer 440 to transfer data via link 448, or the data may definea program. Computer 440 of FIG. 22 may be implemented by a CPU, andpreferably interfaces with either one of the IO modules or humaninterface devices previously described. Computer or controller 440includes a memory 442 containing executable logic or program 444.

This detailed description is presented largely in terms of flowcharts,display images, algorithms, and symbolic representations of operationsof data bits within at least one computer readable medium, such as amemory. An economy is achieved in the present document in that a singleset of flowcharts is used to describe both methods of the invention, andprograms according to the invention. Indeed, such descriptions andrepresentations are the type of convenient labels used by those skilledin programming and/or the data processing arts to effectively convey thesubstance of their work to others skilled in the art. A person skilledin the art of programming may use these descriptions to readily generatespecific instructions for implementing a program according to thepresent invention.

Often, for the sake of convenience only, it is preferred to implementand describe a program as various interconnected distinct softwaremodules or features, individually and collectively also known assoftware and softwares. This is not necessary, however, and there may becases where modules are equivalently aggregated into a single programwith unclear boundaries. In any event, the software modules or featuresof the present invention may be implemented by themselves, or incombination with others. Even though it is said that the program may bestored in a computer-readable medium, it should be clear to a personskilled in the art that it need not be a single memory, or even a singlemachine. Various portions, modules or features of it may reside inseparate memories, or even separate machines. The separate machines maybe connected directly, or through a network, such as a local accessnetwork (LAN), or a global network, such as the Internet.

It will be appreciated that some of these methods may include softwaresteps which may be performed by different modules of an overall parts ofa software architecture. For example, data forwarding in a router may beperformed in a data plane, which consults a local routing table.Collection of performance data may also be performed in a data plane.The performance data may be processed in a control plane, whichaccordingly may update the local routing table, in addition toneighboring ones. A person skilled in the art will discern which step isbest performed in which plane.

In the present case, methods of the invention are implemented by machineoperations. In other words, embodiments of programs of the invention aremade such that they perform methods of the invention that are describedin this document. These may be optionally performed in conjunction withone or more human operators performing some, but not all of them. As perthe above, the users need not be collocated with each other, but eachonly with a machine that houses a portion of the program. Alternately,some of these machines may operate automatically, without users and/orindependently from each other.

Methods of the invention are now described.

Referring now to FIG. 23, a flowchart 2000 is used to illustrate amethod according to an embodiment of the invention. The method offlowchart 2000 may also be practiced by the devices of the inventiondescribed in this document. Above and beyond the method describedherein, the responder (who is also a user) may be instructed on how toapply a device, and or interactively give feedback, and/or to performsteps of the method, etc.

According to a box 2010, signals are received about the patient, andoptionally are also monitored. Optionally, they are also recorded,displayed, transmitted, etc.

The signals are received from the patient (such as ECG), from specialsensors (such as oximetry, impedance, force, pulse detection sensors,etc.). Signals may also be received from other components or devices(size of belt or vest around patient's chest, GPS signals, controlsignals from a device of a responder attending to the patient, etc.).Signals may further be received from the responder interactively, e.g.by asking questions and receiving answers.

The signals are then analyzed and treated as inputs, as is also shown inthe rest of flowchart 2000. Analysis may be implemented also by takingadvantage of the combined functionalities and features. For example,knowledge of the time profile of the chest compression is used to removethe chest compression artifact from the ECG.

The process of box 2010 preferably takes place continuously, even ifexecution moves also to other boxes of flowchart 2000. Monitoring is forthe conditions that are applicable for the below, including, forexample, for the effectiveness of chest compressions. There can bedifferent stages of monitoring, such as main monitoring, at exact box2010, and secondary monitoring concurrent with other stages, e.g. at thesame time as any one of boxes 2030, 2040, 2080 below.

In addition, monitoring may be also for detecting Acute MyocardialInfarction (AMI), via the ECG or other monitoring parameters, andindicating this to the caregiver. If AMI is detected, then monitoringmay also be for cardiac arrest (which commonly occurs during an AMI).

In addition to monitoring, preferably there is also recording. Theaccumulated record may include records of events, data monitored, andfunctionalities of the invention that are operating, and time profilesof their operation.

A number of decision trees may then be implemented, in determining whataction to take next. The best embodiments known to the inventors aredescribed, but that is only by way of example, and not of limitation.Further, the flowchart may be integrated with other steps, such asadministering medications (e.g. cardiac drugs), etc. But simplistically,the ECG input is analyzed for a shockable rhythm, and then eitherdefibrillation takes place, or pulse or other signs of circulation arechecked, following the same protocol as today's AEDs. Further, a userwould be prompted to start the chest compression device and ventilationsif there was no pulse (or no signs of circulation.) A more rigorous wayis described below.

According to a next box 2020, it is determined whether VentricularFibrillation (VF) of the patient's heart is occurring. If so, thenaccording to a next box 2030, the patient is defibrillated. This isaccomplished by administering electrotherapy, such as a defibrillationshock. If a child (“pediatric”) patient is sensed, then thedefibrillation energy level may be adapted automatically (e.g. be set to50J). Such sensing may be from responder inputs, the belt or vest sizewhen tightened around the patient, etc.

In some embodiments of the invention, at box 2030, instead of deliveringa defibrillation shock, the CPR portion is used to deliver a precordialthump to deliver the patient. In particular, when the device detects ashockable rhythm, rather than delivering an electrical defibrillationpulse, the device first deliver a precordial thump to the patient, viathe chest compression device, to attempt defibrillation. This is a greatadvantage of the invention, in that it can revert from one form oftherapy to another.

In yet other embodiments, based on the patient's downtime (which couldbe entered into the device by the caregiver), or by analysis ofparameter that indicates probability of shock success (such as ECG), itmay first be decided whether to deliver electrotherapy, or to firstperform CPR, and/or to first deliver medications prior todefibrillating. That action could either be started automatically by thesystem, or could be started with manual action from the user.

Execution may then return to box 2010, where inputs are received andanalyzed. In a preferred optional embodiment, however, according to anext box 2040, Cardiopulmonary Resuscitation (CPR) is either performedautomatically, or instructed for the responder to perform, afterdefibrillating. Instruction may be by voice commands, and/or may includesounds for the responder to synchronize their action. In addition,depending on the monitored inputs, the repetition rate of the CPR isadjusted. Further, if CPR is performed automatically, the force and itstime profile are also adjusted. Execution returns to box 2010.

According to important alternate embodiments of the invention, boxes2030 and 2040 take place together. In other words, defibrillation takesplace while CPR is being performed automatically.

Referring briefly to FIG. 24, a time profile of the chest compressionsis shown. More particularly, the changing circumference of the patientchest is plotted, as squeezed and released. In addition, the level ofpatient impedance is plotted in dashed lines, following in pattern thetime profile of the chest circumference. (Other impedance variations maybe superimposed on the level of impedance). The profile of chestsqueezing may be known directly, or indirectly from a monitoredparameter such as the level of impedance.

Advantageously, defibrillation (the large lightning bolts in FIG. 24)may take place any time in the CPR cycle. The exact timing is chosen insynchronization to pursue various optimizations. For example, if it isdesired to exploit the smallest possible impedance, defibrillationhappens according to bolt (A). On the other hand, if it is desired toexploit the moment that the heart is filled with the most blood (andthus draw the most current through the heart), then defibrillationhappens according to bolt (B).

CPR may continue after defibrillation, or even be halted after it. Anadvantage of the invention is that the waiting time from CPR todefibrillation is minimized. Pacing takes place as described later inthis document.

Returning to FIG. 23, if, at box 2020 it is determined that the patientis not undergoing VF, then according to an optional next box 2050, it isinquired whether a pulse is detected. If not, then according to anoptional next box 2060, it is inquired whether the condition ofVentricular Tachycardia (VT) is detected. If so, then execution revertsto box 2030, and the patient is defibrillated. But if no VT is detectedat box 2060, then execution reverts to box 2040 for performing CPR.

If a pulse is detected at box 2050, then, according to an optional nextbox 2070, it is inquired whether respiration is detected. If so, thenexecution returns to box 2010. Respiration may be detected automaticallyby respiration sensors, such as a CO2 (carbon dioxide) sensor, chestmovement sensor, or an impedance sensor.

If at box 2070 there is no respiration detected, then according to anoptional next box 2080, ventilation is performed automatically by aventilator, or rescue breathing is instructed for the responder toperform. Execution returns to box 2010.

Since box 2010 is preferably executed continuously, the method alsoincludes discontinuing one type of therapy, and optionally also startinganother consistently with the above. Also, if one of the signs changes,execution may return to box 2010 and start over. For example, pulse maybe lost while ventilating. Or the onset of respiration may detected, inwhich case other activities (such as ventilation) stop.

Referring now to optional box 2090, optional pacing according to theinvention is also described. In the embodiment of FIG. 23, the conditionfor enabling pacing is examined in two circumstances, namely intransitioning from box 2050 to 2070, and also in transitioning from box2060 to 2040.

Referring now to FIG. 25, box 2090 is described in more detail. In bothcases, it is inquired whether severe bradycardia is detected. Inaddition, if no pulse has been detected, it is inquired whetherventricular asystole has been detected. If not, then execution continuesas before (from box 2050 to 2070, and from box 2060 to 2040). If yes,then according to a box 2095, pacing is performed.

Returning to FIG. 24, pacing (shown as a small lightning bolt) may alsobe coordinated with the administration of CPR. Pacing is preferablysynchronized with the compression cycle. There is some evidence thatchest compressions may cause a QRS complex (ventricular depolarization),if the heart is able to support it. Accordingly, pacing during thecompression cycle provides the additional impetus to the ventricles.Also, pacing should be avoided a few 100 msec after a QRS complex,during the ventricular vulnerability period.

At any one time during the method of FIG. 23, inputs are received (formonitoring) from the available sensors, from the user through the I/Omodule, and from the interfaces during communication. Outputs arecommunicated to the user through the I/O module, sometimes through theinterface during implementation.

Referring now to FIG. 26, a sample screen is shown for communicating tothe user the outputs. In the example of FIG. 21, there is a count downfor imminent defibrillation (at the 3 sec point). The screen ispreferably from the “master” device in the relationship. Some of theinputs are generated on board, while others are generated by the otherdevice, and received by the interface.

A person skilled in the art will be able to practice the presentinvention in view of the description present in this document, which isto be taken as a whole. Numerous details have been set forth in order toprovide a more thorough understanding of the invention. In otherinstances, well-known features have not been described in detail inorder not to obscure unnecessarily the invention.

While the invention has been disclosed in its preferred form, thespecific embodiments as disclosed and illustrated herein are not to beconsidered in a limiting sense. Indeed, it should be readily apparent tothose skilled in the art in view of the present description that theinvention may be modified in numerous ways. The inventors regard thesubject matter of the invention to include all combinations and subcombinations of the various elements, features, functions and/orproperties disclosed herein.

1. A method comprising: placing a person on a first device; establishingdata communication between the first device and a second device that canbe physically apart from the first device; causing a chest compressionmember of the first device to compress a chest of the person against thebackboard; causing a defibrillator of the second device to defibrillatethe person responsive to the communication; and establishing a masterdevice as between the first device and the second device.
 2. The methodas in claim 1, in which the master device coordinates chest compressionand defibrillation.
 3. A method comprising: receiving an input that aperson has been placed on an external chest compression (ECC) device;generating instructions to establish communication between a first datacommunication module operably coupled to the ECC device and a seconddata communication module coupled to a defibrillator; generatinginstructions to operate a chest compression member of the ECC device tocompress the person against the backboard; operating the defibrillatorto defibrillate the person in response to the communication; andgenerating instructions to establish a master controller as between afirst controller coupled to the first data communications module and asecond controller coupled to the second data communications controller.4. The method of claim 3, further comprising generating voice outputsinitiated by the master controller.
 5. The method of claim 4, furthercomprising generating voice outputs.
 6. The method of claim 4, in whichthe voice outputs include chest compression instructions.
 7. The methodof claim 4, in which the voice outputs include drug deliveryinstructions.
 8. The method of claim 4, in which the voice outputsinclude manual ventilation instructions.
 9. The method of claim 4, inwhich the voice outputs include instructions to cool the person.
 10. Themethod of claim 4, in which the voice outputs include instructions todeliver a precordial thump.
 11. The method of claim 4, in which thevoice outputs include instructions to manually ventilate the person insynchrony with the chest compression instructions.
 12. An articlecomprising: a storage medium, the storage medium having instructionsstored thereon, in which when the instructions are executed by at leastone device, they result in: receiving an input that a person has beenplaced on an external chest compression (ECC) device and a defibrillatorand sending out the input as data; establishing a master controller asbetween a first controller coupled to the ECC device and a secondcontroller coupled to the defibrillator; and generating instructions inthe master controller to operate a chest compression member of the ECCdevice to compress the person's chest.
 13. An article as in claim 12,further comprising receiving a physiological signal of the person; andoperating the defibrillator to defibrillate the person in response tothe received signal.
 14. An article as in claim 12, in which theoperating the defibrillator is controlled by the master controller. 15.An article as in claim 12, further comprising establishing communicationbetween the ECC device and the defibrillator.
 16. An article as in claim15, in which the operating chest compression is performed responsive tothe communication.
 17. A system comprising: an external chestcompression (ECC) device having a first communication module; adefibrillator havina a second communication module, in which the ECCdevice and the defibrillator are capable of communicating via the firstcommunication module and the second communication module; a firstcontroller and a second controller, in which the first controller isoperably coupled to the ECC device and to the first communicationmodule, in which the second controller is operably coupled to thedefibrillator and to the second communication module; in which the firstand second controllers are configured to designate a master controllerfrom one of the first and second controllers.
 18. A system as in claim17, further comprising at least one sensor coupled to at least one ofthe first and second controllers, in which the master controllerincludes logic to initiate defibrillation responsive to sensor dataindicative of cardiac arrest.
 19. A system as in claim 17, furthercomprising at least one sensor coupled to at least one of the first andsecond controllers, in which the master controller includes logic toinitiate defibrillation responsive to sensor data indicative ofventricular fibrillation.
 20. A system as in claim 17, furthercomprising at least one sensor coupled to at least one of the first andsecond controllers, and further comprising a cooling module, in whichthe master controller initiates cooling using the cooling moduleresponsive to sensor data indicative of cardiac arrest in the person.21. A system as in claim 20, further comprising a human interface modulefor communicating with a human assistant, in which the master controllerinitiates the cooling through instructions issued to the human assistantthrough the human interface module.
 22. A system comprising: an externalchest compression (ECC) device having a first communication module; adefibrillator having a second communication module, in which the ECCdevice and the defibrillator are capable of communicating via the firstcommunication module and the second communication module; a chestcompression member, an electrode disposed on the chest compressionmember, and a first electrical connector electrically coupled to thechest compression member electrode, in which the defibrillator includesa second electrical connector adapted to connect to the first electricalconnector, and in which the first or second controller executes logic toaccept data indicative of the length of cardiac arrest, and in which thefirst or second controller executed logic to perform external chestcompression prior to administering a defibrillation pulse if the lengthof cardiac arrest is greater than a time limit.